Heart Health, Explained
Menopause: Early Menopause and Risk of Heart Failure
There is growing evidence that age at menopause influences risk of cardiovascular disease, including recent studies on stroke and coronary heart disease that found younger age at menopause to be a significant risk factor. However, many of these studies were based on small populations and did not follow a group of women over a long period. Now, in the first large-scale (including more than 22,000 postmenopausal women) and long-term study, researchers from the Karolinska Institute in Sweden determined that women who experience early menopause are at higher risk of developing heart failure compared to women who experience menopause at the usual age. Smoking, current or past, raises the risk even more, according to the study published in the journal Menopause, and publicized in Science Daily on May 14, 2014.
Frequently Asked Questions
- Q: The usual age for menopause is between 50 and 54. How did the researchers define early menopause?
A: The researchers defined early menopause as occurring between 40 and 45 years of age. This was defined as age at last menstrual period and was self-reported by the women in this study. Menopausal onsets and rates are influenced by a combination of factors including heredity, smoking, diet and exercise.
- Q: How much higher was the risk of heart failure in the early menopause group?
A: Heart failure is a condition in which the heart muscle is unable to pump enough blood to meet the body's needs. The investigators reported 2,532 first-time hospitalizations for heart failure among the early menopause population. This population of women who entered menopause between 40 and 45 years of age had a 40 percent increased risk for heart failure compared with women who entered menopause between age 50 and 54 years. For every one-year increase in the age when a woman began menopause, there was a 2 percent lower risk of heart failure.
- Q: What might cause early menopause to be associated with a higher risk of developing heart failure?
A: The researchers speculate that early menopause may predispose women to early coronary artery disease and eventual heart failure by adversely altering their cholesterol levels. Menopause is a process during which a woman's reproductive and hormonal cycles slow and eventually stop, as the ovaries produce less estrogen and progesterone.
- Q: How were the Swedish researchers able to obtain the necessary health information on more than 22,000 women for this study?
A: This study was possible using the Swedish National Patient Register, which captures Sweden's hospitalization and outpatient diagnoses; Sweden's Cause of Death Register; and voluntary health surveys of some 90,000 women in the Swedish Mammography Cohort. This is an example of a “population study,” which is an examination of a group of individuals taken from the general population who share a common characteristic, such as age, sex, or health condition.
- Q: How does smoking affect the association between early menopause and increased risk of heart failure? Besides quitting smoking, can you recommend other ways to reduce cardiovascular disease risks?
A: Research has shown that smokers reach menopause, on average, two years earlier than non-smokers do, so quitting smoking may delay the onset of menopause. Risk factors for heart and vascular disease start very early in life, even though heart attacks, heart failure, and strokes occur later in life. Unfortunately, young women often receive very little education and instruction on the prevention of heart and vascular disease, most likely because heart and vascular disease are believed to occur only in men and older women. Managing risk factors when women are young will likely prevent or postpone heart attacks, heart failure, and strokes when they age. Strategies to reduce the risk of developing heart disease include special attention to blood pressure control as well as lifestyle modifications, such as eating a healthy diet, weight loss, stress management, and regular exercise.
Teresa Caulin-Glaser, MD, FACC, FAACVPR System Vice President, Heart & Vascular Services OhioHealth Healthcare System, Columbus, Ohio
Heart Health Explained is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.
The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.